123 Magnolia St RERF19-0180 Shingle O+ t REROOF SHINGLE PERMIT PERMIT NUMBER
r) CITY OF ATLANTIC BEACH RERF19-0180
800 SEMINOLE ROAD ISSUED: 12/13/2019
r5 ATLANTIC BEACH. FL 32233 EXPIRES: 6/10/2020
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
that may be found in the public records of this county,and there may be additional permits required from other
governmental entities such as water management districts,state agencies,or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
123 MAGNOLIA ST REROOF SHINGLE SHINGLE ROOF $8400.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170627 0100 SALTAIR SEC 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
FLORIDA ROOFING 4320 DEERWOOD LAKE PARKWAY
EXPERTS 1001-403 JACKSONVILLE FL 32216
OWNER: ADDRESS: CITY: STATE: ZIP:
PETWAY TOM 123 MAGNOLIA ST ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $95.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $99.00
Issued Date: 12/13/2019 1 of 2
.'S"'`'./.„4„ REROOF SHINGLE PERMIT PERMIT NUMBER
J
s� RERF19-0180
7-.: s, CITY OF ATLANTIC BEACH
�-6a� ISSUED: 12/13/2019
, 800 SEMINOLE ROAD
�o'3 9.--- EXPIRES:BEACH. FL 32233 EXPIRES: 6/10/2020
Issued Date: 12/13/2019 2 of 2
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
-DU� IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
123 ii ov.a S-r 31133 RTl °l - C71 S O
Job Address: Permit Number:
Legal Description %\'r O i r c7€L 3 � t" ( RE# l 7(5(oz-7-0100
Valuation of Work(Replacement Cost)$ \O0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New DAddition ❑Alteration/'kepair ❑Move ❑Demo DPool DWindow/Door
• Use of existing/proposed structure(s): ❑Commercial 'Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proposed project? HYes(must submit separate Tree Removal Permit) ofNo
Describe in detail the type of work to be performed: ike,roo FU*tor-V-1 - 1E3.O ')htYIc,*
2y btt (\\z i' -\ Ortkkkyrr o
Florida Product Approval# Cj ,, '''IOoV-Zy- X20 _ for multiple products use product approval form
Property Owner Information " (/�^tA-5- i• IDZ.Z_CD
Name e T�'rt4 L1 Address 2233 illOke AO- i2
City_141,-\‘../1L. 1 State Zip Z1=2-33 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company"VIDcE,c Qualifying Agent—77-cA,kiir- atofS-Ce
L�Add ressC � LAO'S City ILS011uillf State (rL Zp 3111 (�
Office Phone
tot 3226-014 LP ` Job Site Contact Number
State Certification/Registration#CLC.1329d°l E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer F;CSS ar \Z OR Exempt❑ Expiration Date lZ•
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
R RDING YO R OTICE OF COMMENCEMENT.
(Signature of Owned r Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this(O day of Signed and sworn to(or affirmed)before me this I` tidy of
c , a-Glc1 , by ?-W P€ x / be ,'LO%q , by VeAA/'rb Cy. 1c,v4Cr
�� - �-- prem
Gran aLkng ature gnature of Notary)'�Iriaa
Com*Pion/G0214521Y TIFFANY NEAL
'+ , € ersonall Kn MY COMMISSION#GG229074
Personally Known OR � � r1I�Ohty V dwn OR 1)°,,'-°"
ff EXPIRES:JUN 14,2022
(� oduced Identification K�` 1dedht. ( ] Produced Identification ) Bonded through 1st State Insurance
Type of Identification: P L'1 L- _ ___ Type of Identification:
NOTICE OF COMMENCEMENT
State of Tax Folio No.
County oft
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENC MENT.
Legal Description of property being improved: ,\—G•\r SQ(_ 3 Lc (,p L'
Address of property being improved: '2,J � 1r'1 C) "wr
General description of improvements: SQcQX
Owner:CQVIt`C_ ?e.4-wc,.LA Address: 2233 Sem jn`�le 1`6 12
Owner's interest in site of the improvement: +��; f l( t ik.11 VII I '6Z.`7
Fee Simple Titleholder(if other than owner):
Name: c-
Contractor, F\OC(\�, ectt E.)wer
AaiAddress: �13Zh V ec jO6a. (.�^ _ �
K-Cr-L 43
Jl� 3ZZ\
Telephone No.( )3'L%-(of Lilo Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may
be served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one (1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNE
Doc#2019284646,OR BK 19036 Page 288,
Signed: q"�\ NW Date: / L
Number Pages:1 Before e is (0 day of 10_ - in the Coun of uva,State
Recorded 12/13/2019 08:28 AM, Of Florida,has personally appeared V1/41 E -VCc�
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Notary Public at Large,State of Florida,Count of Duv .��
COUNTY \\./ `
RECORDING $10.00 (>,
My commission expires }
/`
Personally Known: . � eK�aor
Produced Identification: C--
" '#, Bonded gni Mron Norm